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Age-related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a progressive eye disease that affects the macula, the central part of the retina responsible for sharp, detailed vision. It is one of the leading causes of irreversible vision loss in people over 50 years of age.

AMD primarily affects central vision, making it difficult to read, drive, recognise faces, and perform tasks requiring fine vision. Peripheral (side) vision usually remains intact, so complete blindness is uncommon. However, the condition can significantly impact a person’s independence and quality of life.

How common is AMD?

AMD affects nearly 200 million people worldwide, and the number continues to rise due to increasing life expectancy. The risk increases significantly after the age of 50 and is highest among people aged 80 years and above.

Why does AMD occur?

AMD develops due to a combination of age-related retinal changes, oxidative stress, chronic inflammation, genetic factors, and environmental influences.

Over time, waste deposits known as drusen accumulate beneath the retina, damaging retinal cells and affecting vision. In advanced stages, abnormal blood vessels may develop beneath the retina, leading to rapid vision loss.

Risk factors

The major risk factors for AMD include:

  • Increasing age (especially over 50 years)
  • Smoking
  • Family history of AMD
  • High blood pressure
  • Cardiovascular disease
  • Obesity and high cholesterol
  • Excessive sunlight exposure
  • A diet low in antioxidants

Smoking is the most important preventable risk factor and can significantly increase the risk of disease progression.

Types of AMD

Dry AMD (Non-neovascular AMD)

Dry AMD accounts for approximately 85–90% of all cases. It develops gradually due to the accumulation of drusen and progressive degeneration of retinal cells.
Symptoms include:

  • Blurred central vision
  • Difficulty reading
  • Reduced contrast sensitivity
  • Slower adaptation to dim light

In advanced stages, geographic atrophy (GA) may develop, resulting in permanent central vision loss.

Wet AMD (Neovascular AMD)

Wet AMD accounts for only 10–15% of cases but is responsible for most severe vision loss associated with AMD.
It occurs when abnormal blood vessels grow beneath the retina and leak fluid or blood.
Symptoms include:

  • Sudden decrease in vision
  • Distorted or wavy lines (metamorphopsia)
  • Dark or blank spots in central vision
  • Rapid deterioration of vision

Without timely treatment, wet AMD can lead to irreversible scarring and permanent vision loss.

Diagnosis

Modern retinal imaging allows early and accurate diagnosis of AMD.
Common investigations include:

  • Optical coherence tomography (OCT), the most important imaging test for diagnosis and monitoring
  • Fundus examination to identify drusen and retinal changes
  • Fundus fluorescein angiography (FFA) to detect leaking abnormal blood vessels
  • OCT angiography (OCTA), a non-invasive technique for visualising retinal blood vessels

Treatment of dry AMD

There is currently no cure for dry AMD, but its progression can often be slowed.
Recommended measures include:

  • AREDS2 nutritional supplements
  • Smoking cessation
  • A healthy diet rich in green leafy vegetables and antioxidants
  • Regular eye examinations
  • Home monitoring using an Amsler grid

Treatment of wet AMD

The introduction of anti-VEGF therapy has transformed the management of wet AMD.
Anti-VEGF medications help stop the growth of abnormal blood vessels and reduce leakage beneath the retina.
Commonly used anti-VEGF medications include:

  • Ranibizumab
  • Aflibercept
  • Bevacizumab
  • Faricimab
  • Brolucizumab

Treatment is administered through intravitreal injections and usually requires regular follow-up with repeat injections as needed. Early treatment offers the best chance of preserving vision.

The primary goal of treatment is to prevent further progression of the disease rather than restore vision that has already been lost.

Early diagnosis and regular anti-VEGF injections can help preserve useful vision for many years.

Prognosis

Dry AMD

  • Progresses slowly over several years
  • Peripheral vision usually remains preserved
  • Central vision may gradually decline

Wet AMD

  • Can cause rapid vision loss
  • Early diagnosis and prompt anti-VEGF treatment can preserve useful vision for many years

Possible complications

Advanced AMD may lead to:

  • Geographic atrophy
  • Subretinal fibrosis
  • Retinal pigment epithelial tears
  • Disciform scarring
  • Permanent central vision loss

Regular monitoring is essential, as disease recurrence can occur even after successful treatment.

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